Does Network Health Insurance Corporation require prior authorization for Emsam?
Network Health Insurance Corporation does not require prior authorization for Emsam on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| 24 HR selegiline 0.25 MG/HR Transdermal System [Emsam]865208 | 8 / 8 | 0 | 0 | 8 | No prior authorization |
| 24 HR selegiline 0.375 MG/HR Transdermal System [Emsam]865212 | 8 / 8 | 0 | 0 | 8 | No prior authorization |
| 24 HR selegiline 0.5 MG/HR Transdermal System [Emsam]865216 | 8 / 8 | 0 | 0 | 8 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 24 HR selegiline 0.25 MG/HR Transdermal System [Emsam]
Emsam has 3 products in the corpus; this table is for 24 HR selegiline 0.25 MG/HR Transdermal System [Emsam], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Network Health Anywhere (PPO) | H5215-010 | 5 | No | No | Yes |
| Network Health Cares (PPO D-SNP) | H5215-007 | 5 | No | No | Yes |
| Network Health Choice (PPO) | H5215-011 | 5 | No | No | Yes |
| Network Health Go (PPO) | H5215-009 | 5 | No | No | Yes |
| Network Health PlusRx (PPO) | H5215-002 | 5 | No | No | Yes |
| Network Health PremierRx (PPO) | H5215-005 | 5 | No | No | Yes |
| Network Health Select (PPO) | H5215-008 | 5 | No | No | Yes |
| Network Health Zero (PPO) | H5215-012 | 5 | No | No | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
We publish the hash of the exact file we ingested so any answer can be audited against the bytes CMS served that day.
Emsam at other payers
Or see Emsam across every payer at once.
Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.